Provider Demographics
NPI:1245563725
Name:REDMOND, JOSEPHINE WALKER DION (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPHINE WALKER
Middle Name:DION
Last Name:REDMOND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:WALKER
Other - Last Name:DION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8906 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6366
Mailing Address - Country:US
Mailing Address - Phone:803-254-3676
Mailing Address - Fax:803-254-3678
Practice Address - Street 1:457 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2766
Practice Address - Country:US
Practice Address - Phone:843-781-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1448363A00000X
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0879PAMedicaid
SCP00928290OtherRR MEDICARE
SCP00928290OtherRR MEDICARE
SCAA44335277Medicare PIN